This K-23 Mentored Patient Oriented Development Award application requests support to investigate the neurobiology of poor insight in early schizophrenia. The clinical significance of insight function is underscored by the fact that an international study by the World Health Organization reported poor insight to be the most common symptom in patients with schizophrenia. This clinical relevance is further highlighted by relationship between impaired insight and treatment discontinuations. Although treatment discontinuations impact clinical outcome during all illness phases, they are of greater significance during early schizophrenia, when such treatment interruptions may exacerbate brain dysfunction and compromise treatment responsiveness and long-term outcome. Thus, it is not surprising that poor insight has been linked with deficits in social functioning, poor outcome, re-hospitalization, and increased utilization of emergency services. Despite its clinical significance, neurobiology of insight remains a vastly understudied area, which may explain the lack of successful insight enhancing strategies. During the past 6 years, the applicant has conducted research to investigate the neurobiology of insight in volunteers with early schizophrenia, while using structural and more recently functional magnetic resonance imaging (MRI). The preliminary findings from this research show relationship between poor insight and specific brain regions, which are also involved in self-awareness. Accordingly, the research plan aims to: 1) assess structural brain changes associated with poor insight using structural imaging and 2) identify the functional changes associated with poor insight by using functional MRI task for self-awareness. To achieve these aims, the applicant requires formal training in: 1) cognitive neuroscience; 2) functional MRI methods and analysis; and 3) advanced biostatistics and epidemiology. These skills will enable the applicant to develop expertise and a program of research to investigate the neurobiology of insight deficits in early schizophrenia. [unreadable] [unreadable] [unreadable]